Prevention Systematic review and meta-analysis
Intermittent pneumatic compression is effective in reducing venous thromboembolism risk in hospitalised patients 10.1136/eb-2013-101583
Luigi Pascarella University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA Correspondence to: Luigi Pascarella, MD, Assistant Professor of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, 1525 JCP, 200 Hawkins Drive, Iowa City, IA 52242, USA; [email protected].
Commentary on: Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation 2013;128:1003–20.
Context The Center for Disease Control and Prevention reports incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in 1–2 patients/ 1000/year. A total of 60–100 000 patients in the USA die of DVT or PE annually, with 10–30% expiring within 1 month of diagnosis. Recurrence rates of DVT/PE are as high as 33% within 10 years.1 Increased incidence of DVT and PE has been reported among hospitalised and critically ill patients. DVT risk in this subset can be as high as 81% without thromboprophylaxis and 44% with thromboprophylaxis, while 12% progress to PE in spite of thromboprophylaxis treatment.2 While thromboprophylaxis is considered the standard of care in these patients, anticoagulant use has been associated with increased bleeding in patients with haemorrhagic diathesis. Recent guidelines suggest the use of intermittent pneumatic compression (IPC) or thromboembolic deterrent stockings (TEDS), in combination with pharmacological thromboprophylaxis in patients with low or moderate bleeding risk. Grade 2C evidence suggests IPC and/or TEDS should be used in patients with highbleeding risk.3
Methods This is a stratified meta-analysis of randomised controlled trials comparing IPC to pharmacological thromboprophylaxis, TEDS and no DVT/PE prophylaxis. The Cochrane, EMBASE and MEDLINE databases were searched. Trials that used IPC
Intermittent pneumatic compression is effective in reducing venous thromboembolism risk in hospitalised patients 10.1136/eb-2013-101583
Luigi Pascarella University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA Correspondence to: Luigi Pascarella, MD, Assistant Professor of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, 1525 JCP, 200 Hawkins Drive, Iowa City, IA 52242, USA; [email protected].
Commentary on: Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation 2013;128:1003–20.
Context The Center for Disease Control and Prevention reports incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in 1–2 patients/ 1000/year. A total of 60–100 000 patients in the USA die of DVT or PE annually, with 10–30% expiring within 1 month of diagnosis. Recurrence rates of DVT/PE are as high as 33% within 10 years.1 Increased incidence of DVT and PE has been reported among hospitalised and critically ill patients. DVT risk in this subset can be as high as 81% without thromboprophylaxis and 44% with thromboprophylaxis, while 12% progress to PE in spite of thromboprophylaxis treatment.2 While thromboprophylaxis is considered the standard of care in these patients, anticoagulant use has been associated with increased bleeding in patients with haemorrhagic diathesis. Recent guidelines suggest the use of intermittent pneumatic compression (IPC) or thromboembolic deterrent stockings (TEDS), in combination with pharmacological thromboprophylaxis in patients with low or moderate bleeding risk. Grade 2C evidence suggests IPC and/or TEDS should be used in patients with highbleeding risk.3
Methods This is a stratified meta-analysis of randomised controlled trials comparing IPC to pharmacological thromboprophylaxis, TEDS and no DVT/PE prophylaxis. The Cochrane, EMBASE and MEDLINE databases were searched. Trials that used IPC
